Michael D Bauer, M.D.
Individual provider Active NPI Pediatrics Physician · Lake Bluff, IL
NPI 1881635530 · NPPES record last updated Mar 20, 2015
Key facts
- NPI
- 1881635530
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 3672939 (IL)
- Practice address
- 917 Sherwood Dr
Lake Bluff, IL 60044-2203 - Phone
- (847) 295-1220
- Fax
- (847) 295-1255
- NPI assigned
- Jun 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3672939 | IL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rush University Medical Center | Pediatrics | Past | Accepting new patients |
| Lake Forest Pediatric Associates, LTD | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- michael.bauer.1@29161.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 3672939 | IL | Yes |
Addresses
Primary practice location
917 Sherwood Dr
Lake Bluff, IL 60044-2203
Mailing address
917 Sherwood Dr
Lake Bluff, IL 60044-2203
Phone (847) 295-1220
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3672939 | Medicaid | IL |
Other providers in Lake Bluff, IL
- Robert Alfred Bahlmann
- Samantha Patricia Bailey
- Danielle Marie Baran
- Joseph John Baric Jr.
- Kristel E Bauer
- Mofoluke Olubunmi Bayode
- Bee Happy Therapy PLLC
- Nicolle Bek
- Beneficent Anesthesia LTD
- Jessica Marie Bess
All providers in Lake Bluff, IL · Pediatrics Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.